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Dietary Supplements, 4th Edition

Dietary Supplements, 4th edition, by Pamela Mason. London: Pharmaceutical Press, 2012. Hardcover, 548 pages. ISBN: 978-0-85369-883-8. $85.00.

When I was asked to review the latest edition of Dietary Supplements by Pamela Mason, PhD, I was a bit conflicted. I had recently edited 2 similar books — Prescriptions for Nutritional Healing (Avery Publishing, 2010) and Prescriptions for Herbal Healing (Avery Publishing, 2012). Thus, I secretly hoped this book didn’t measure up to mine. I was wrong.

Dr. Mason, who has a doctorate in nutrition, has written a reference book using an encyclopedic format in which key dietary supplements (herbs, vitamins, et al.) are evaluated. It is written for those pharmacists, nurses, physicians, and dietitians who have less knowledge of dietary supplements than some of their patients. The book is presented in such a fashion that a busy clinician can easily find a specific dietary supplement and see if it is appropriate for his or her patient. One of the book’s most useful features is the summary table at the end of each section, which draws pithy and sensible conclusions about using the supplement for a particular clinical condition. I think that Dr. Mason must have erred on the side of caution, however, because when one reads these summaries, one would think that nothing worked. That can’t be true given the robust sales of dietary supplements and the reported benefits to many people.

No book can claim to be all-inclusive, but Dr. Mason’s book hits the highlights of the most commonly used supplements, except for maybe St. John’s wort (Hypericum perforatum, Hypericaceae) and saw palmetto (Serenoa repens, Arecaceae). The book has a well-written style and uses a linear format that is the same for each entry. The literature reviews are extensive, with most of the key references included. The author correctly (and graciously) summarized the snafu regarding policosanols and the Cuban data, the extensive sports studies on quercetin, and also included interesting probiotics like Lactobacillus plantarum (Lactobacillaceae) and Saccharomyces boulardii (Saccharomycetaceae) for antibiotic-associated diarrhea. However, lacking was mention of probiotic strains for vaginosis (L. rhamnosus and L. reuteri), each with multiple supportive studies. Some other omissions include newer forms of folic acid (L-methylfolate) for women with defective genes for folic acid metabolism; the study that showed increased mortality from multivitamin use (but this may not have been published before the book went to print); and in the vitamin E discussion, there was no consideration that the null results (or even harmful results) were related to the use of alpha-tocopherol, rather than mixed tocopherols. But these are minor omissions, and the majority of the important clinical studies are present.

As I did my doctoral work on omega-3 fatty acids, I read with interest Dr. Mason’s thoughtful assessment of how they are involved with heart disease. This should be required reading for anyone treating patients using fish oil. Omega-3s, as Dr. Mason pointed out, do not work by lowering total and LDL-cholesterol, but rather work by other mechanisms (which is well supported by the literature). It is an excellent section, but I wished that there was more discussion of algae-based DHA (an omega-3 fatty acid) science; products containing this supplement are quite popular in the US.

I particularly like the tables of the nutrient contents of substances such as chlorella, royal jelly, and spirulina. Most people have no idea what is in these things. In addition, the author lists tables of food sources where one can get the same nutrient being discussed. Such information is included for fish oils, folic acid, calcium, and magnesium. Some foods listed are available mostly in the UK, but there are enough food sources listed for Americans to understand sources of the supplement being discussed. This is an excellent way for a healthcare provider to offer patients the best of both worlds — supplements and foods.

Importantly, the book is very UK-focused in its spelling (e.g., diarrhoea, fibre, oestrogen) and emphasis on British nutrient needs and surveys, as well as European regulations. The US dietary nutrient guidelines are included (Estimated Average Requirements [EAR], Recommended Dietary Allowances [RAD], and Tolerable Upper Intake Levels [UL]), but it would have been more useful if the Percent Daily Value (%DV) also was included, as this is the reference value on dietary supplement labels. There was no mention of the new Good Manufacturing Practices for Dietary Supplements in the United States or that the US Federal Trade Commission has a key role in dietary supplement regulation. Finally, the US Food and Drug Administration’s health claim on phytosterols was omitted. So, this isn’t a book one can buy to learn about US dietary needs or regulation. Rather, this is a somewhat thorough review of the published human science on selected dietary supplements. To that end, the studies reviewed by Dr. Mason are relevant for both sides of the Atlantic.

At the end of the book, I wasn’t sure why the section “Additional Resources” was included. The list was short and the items didn’t seem that relevant to healthcare professionals. Also, there was no index, which is fine as the book is alphabetized by supplement. However, if a patient wants advice on which supplements to take for a specific condition, there is no way a healthcare provider can find that information readily.

In terms of writing an encyclopedic reference book on dietary supplements, Dr. Mason achieved her goal. Despite a few minor limitations, I would strongly recommend this book to any healthcare provider who sees patients who regularly use dietary supplements. I am happy to have a copy and will certainly be using it often.

—Stacey Bell, DSc, RD Nutritional Consultant Boston, MA